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Rapid Recovery Without Pre-implant Reanimation In Donation After Circulatory (dcd) Heart Transplantation For Adult Congenital Heart Disease (achd) Recipients
Aaron Michael Williams, MD, Swaroop Bommareddi, MD, Kevin McGann, MD, Awab Ahmad, MD, Charles Wang, MD, John Trahanas, MD, Brian Lima, MD, Garrett Coyan, MD, David Bichell, MD, Ashish Shah, MD, Matthew Bacchetta, MD, Yishay Orr, MD, Carlos Mery, MD, Ziv Beckerman, MD.
Vanderbilt, Nashville, TN, USA.
Objective(s): Donor heart reanimation remains the standard in donation after circulatory death (DCD) transplantation using NRP or ex situ perfusion platforms. Recently, alternative strategies including rapid recovery with extended ultraoxygenated preservation (REUP) have been used to recover DCD hearts without pre-implant reanimation. Although promising, this has not been evaluated in the adult congenital population to date.
Methods: A single-center retrospective case series of adult congenital heart disease (ACHD) recipients who underwent DCD heart transplantation without pre-implant reanimation using REUP from November 2024 to January 2026 was performed.
Results: Six ACHD recipients underwent DCD heart transplantation using REUP. All ACHD recipients (100%) had transposition of the great arteries (TGA). The median donor age was 41 (IQR, 38-44). The median asystolic warm ischemic time was 9 minutes (IQR, 8-10). The median total ischemic time was 249 minutes (IQR, 234-271). There was no (0%) severe primary graft dysfunction and no (0%) new IAPB placement postoperatively (Table 1). Median hospital stay was 23 days (IQR, 18-31). There was one (1/6, 16.7%) instance of acute cellular rejection, grade 2 or higher. Thirty, 90-, and 180-day survival was 100%.
Conclusions: In the first series of rapid recovery without pre-implant reanimation for ACHD recipients, REUP appears to be safe and affords excellent outcomes. Although further study is needed in this high-risk recipient population, early outcomes appear promising.
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